| (1) A designated maternal facility must provide written
or electronic notification of any significant change to the maternal
program impacting patient care. The notification must be provided
to the following:
(A) all emergency medical services (EMS) providers
that transfer maternal patients to or from the designated maternal
facility;
(B) the hospitals to which it customarily transfers
out or transfers in maternal patients;
(C) applicable PCRs and RACs; and
(D) the department.
(2) If the designated maternal facility is unable to
comply with requirements to maintain its current designation, it must
submit to the department a POC as described in subsection (a)(1)(D)(i)
- (vi) of this section, and a request for a temporary exception to
the designation requirements. Any request for an exception must be
submitted in writing from the Chief Executive Officer of the facility
and define the facility's timeline to meet the designation requirements.
The department reviews the request and the POC, and either grants
the exception, with a specific timeline based on the public interest,
geographic maternal care capabilities, and access to care, or denies
the exception. If the facility is not granted an exception, or it
does not meet the designation requirements at the end of the exception
period, the department will elect one of the following:
(A) re-designate the facility at the level appropriate
to its revised capabilities;
(B) outline an agreement with the facility to satisfy
all designation requirements for the level of care designation within
a time specified under the agreement, which may not exceed the first
anniversary of the effective date of the agreement; or
(C) waive one specific designation requirement for
a level of care designation if the facility meets all other designation
requirements for the level of care designation and the department
determines the waiver is justified considering:
(i) the expected impact on accessibility of maternal
care in the geographic area served by the facility if the waiver is
not granted and the expected impact on the quality of care and patient
safety; or
(ii) whether these services can be met by other facilities
in the area or with telehealth/telemedicine services.
(3) Waivers expire with the expiration of the current
designation but may be renewed. The department may specify any conditions
for ongoing reporting during this time.
(4) The department maintains a current list on their
internet website of designated facilities that have an approved waiver
with the department and an aggregated list of the requirements waived.
(5) Facilities that have contingency agreements or
an approved waiver with the department must post on the facility's
internet website the nature and general terms of the agreement.
(s) An application for a higher or lower level of maternal
designation may be submitted to the department at any time.
(1) A designated maternal facility that is increasing
its maternal capabilities may choose to apply for a higher level of
designation at any time. The facility must follow the designation
process as described in subsection (a)(1) and (2) of this section
to apply for the higher level.
(2) A designated maternal facility that is unable to
maintain the facility's current level of maternal designation may
choose to apply for a lower level of designation at any time.
(t) If the facility is relinquishing its maternal designation,
the facility must provide 30 days written, advance notice of the relinquishment
to the department, the applicable PCRs/RACs, EMS providers, and facilities
it customarily transfers out or transfers in maternal patients. The
facility is responsible for continuing to provide maternal care services
or ensuring a plan for maternal care continuity for the 30 days following
the written notice of relinquishing its maternal designation.
(u) A hospital providing maternal services must not
use the terms "designated maternal facility," or similar terminology
in its signs, advertisements, facility internet website, social media,
or in the printed materials and information it provides to the public,
unless the facility is currently designated at that level of maternal
care.
(v) During a virtual, on-site or focused designation
review, conducted by the department or survey organization, the department
or surveyor has the right to review and evaluate maternal patient
records, maternal multidisciplinary QAPI Plan documents, and any action
specific to improving maternal care and outcomes, as well as any other
documents relevant to maternal care in a designated maternal facility
or facility seeking maternal facility designation to validate designation
requirements are met.
(w) The department and survey organization will comply
with all relevant laws related to the confidentiality of records.
(x) The department may deny, suspend, or revoke designation
if a designated maternal facility ceases to provide services to meet
or maintain the designation requirements of this section.
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